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FULL BLOOM THERAPY & CONSULTING NPI 1770049769


NPI Information

NPI: 1770049769
Provider Name: FULL BLOOM THERAPY & CONSULTING
Classification: Clinic/Center - 261QM0855X
Entity Type: Organization

Specialization: Adolescent and Children Mental Health

Address:
153 PARK ROW STE 204
BRUNSWICK, ME
ZIP 04011
Phone: (207) 837-6599
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FULL BLOOM THERAPY & CONSULTING is an adolescent and children mental health clinic center in Brunswick, ME. The provider is an entity, facility, or distinct part of a facility providing diagnostic, treatment, and prescriptive services related to mental and behavioral disorders in children and adolescents. Services may be provided to parents and family members of the patient in the form of conjoint, group, or individual therapy, and education and/or training. FULL BLOOM THERAPY & CONSULTING NPI is 1770049769. The provider is registered as an organization entity type.

The provider's business location address is:

153 PARK ROW STE 204
BRUNSWICK, ME
ZIP 04011-053
Phone: (207) 837-6599

The provider's authorized official is Stacey Michelle Jenkins .
The authorized official title is Owner and has the following contact phone number (207) 837-6599.

The enumeration date for this NPI number is 2/14/2019 and was last updated on 2/14/2019.


Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.Taxonomy CodeTaxonomy ClasificationTaxonomy SpecializationLicense NumberLicense StatePrimary
1261QM0855XClinic/CenterAdolescent and Children Mental HealthYes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.Other Provider IdentifierOther Provider Identifier TypeOther Provider Identifier StateOther Provider Identifier Issuer
11780018119MEDICAIDMAINE

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 11/14/2023

All materials and services on this site are provided on an "as is" and "as available" basis without warranty of any kind. The NPI record is maintained by the National Plan & Provider Enumeration System (NPPES) and anyone may request this information and other NPPES health care provider data from HHS under The Freedom of Information Act (FOIA), Title 5 of the United States Code, section 552. To update the NPI records please contact the NPPES.